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Back Pain: Moving the Needles

An acupuncturist inserts needles into a patient suffering back pain. (M. Spencer Green/AP)

Six months of acupuncture provides more relief for back pain than conventional treatments, according to a large new study. But surprisingly, fake acupuncture works just as well as the real thing.

The German study of nearly 1,200 patients, published today in the Archives of Internal Medicine, is the largest and most rigorous analysis yet of the use of acupuncture to treat back pain. Some of the patients received real acupuncture, which involves inserting thin needles deeply into the skin at specific points on the body. The acupuncturist then manipulates the needles to create a numb radiating sensation called de qi.

Another group received sham acupuncture: the needles were inserted around the back and legs, but only superficially, without manipulation and at points that aren’t traditional acupuncture sites. A third group received treatments based on their doctors’ recommendations, including physical therapy, massage and exercise.

All the study participants met regularly with their doctors, and each patient’s response to treatment was measured on a pain scale, as was the amount of pain medication required.

Nearly half the patients in the acupuncture group reported significant relief, compared to just 27 percent in the conventional therapy group. But nearly as many people in the fake acupuncture group — 44 percent — also reported significant relief.

Real acupuncture did reduce the need for pain medicine. Only 15 percent of patients who received real acupuncture used extra pain medication, but 34 percent of patients in the sham group and 59 percent of patients in conventional therapy needed extra pain pills.

The fact that both the real and the fake forms of needle treatment had such a similar effect was surprising, said the study authors. It may be that the benefits of acupuncture have something to do with the way the body transmits or processes pain signals. Or it could be that the needles caused a “super placebo” effect, triggering a real reaction in the brain that changes the way the body perceives and responds to pain.

The German study, interestingly, was funded by several insurance companies. A 2004 study funded by the National Institutes of Health similarly showed that acupuncture relieved knee pain related to arthritis. The National Center for Complementary and Alternative Medicine offers more information about acupuncture treatments and research. And on a historical note, here’s a New York Times story (pdf) from 1971 that the center cites as the impetus for raising awareness about acupuncture in the United States.

This is not the first time it has been noticed that there may not be much difference between “correct” accupuncture and relatively random needling.

Citation from Wikipedia:
Felix Mann, founder and past-president of the Medical Acupuncture Society (1959–1980), the first president of the British Medical Acupuncture Society (1980), and the author of the first comprehensive English language acupuncture textbook Acupuncture: The Ancient Chinese Art of Healing’ first published in 1962, has stated in his book Reinventing Acupuncture: A New Concept of Ancient Medicine:

“The traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes.” (p. 14)

and…

“The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and tried to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in [acupuncture] meridians.” (p. 31)[15]

Mann goes on to describe a much less formal use of needles that has worked for him for many years.

Interesting article, but it lacks sufficient information about the points chosen for the ‘sham acupuncture’ part.

There are other points in the body, some of them very close to the surface of the skin, which control muscles — namely, the trigger points. Dry needling of trigger points is a well-known method to neutralize muscle spasm, and the sensations produced can be similar to the ‘de qi’ ones.

If the ‘sham’ points belong to another effective therapeutic system, it would be then most logical that both the real and sham acupuncture used in this study produced positive results.

One must realize that oriental medicine is based upon a different philosophical model and paradigm than Western medicine. The principles of oriental medicine are rooted in Buddhism, Confucianism and (mostly) Taoism. The Taoists’ observations of the universal laws of nature became very practical ideas of health.

It does not surprise me that the so-called “sham” acupuncture relieved a significant percentage of patients’ pain. Oriental medicine treats the body as a whole, with all parts reflected by and dependent upon the others. Just as we are now discovering in our own environment, the smallest, most subtle change in one area can cause a dramatic change elsewhere. The environment of the human body obeys these same universal principles.

Because we in the West have not yet discovered or do not yet understand these relationships does not mean they do not exist. Until we do thoroughly understand, oriental Medicine should be judged by its results. When judged by its results it proves to be an effective, safe, economically efficient and complete health care system.

Qi is everywhere — the entire body is qi. There are concentrated pathways, meridians that run through the body, and direct stimulus to the concentrated areas generally has a stronger effect than needling areas not on the meridians. But you will stimulate qi anytime you stimulate the body.

I am glad that both acupuncture groups experienced relief, but you cannot conclude that it was due to a treatment effect if the sham group outcomes were statistically significant as well. You can only conclude that using acupuncture needles, whether true treatment or sham, is effective when following this study’s methods.
You also cannot conclude that it is better than “traditional” therapies like physical therapy, which is just bundled in with the medical approach. The problem with a study like this is the so called “conventional” treatment is not very effective in chronic cases. The physical therapy in most of these studies is just passive modalities, considering they list exercise as separate. Quality orthopedic manual physical therapy, when combined with exercise, has much better results, and the studies show superior outcomes to when compared to exercise alone or manual therapy alone (and the traditional rest and medication approach).

As a physical therapist who has specialized in treating back pain for the past 18 years, I can say that in certain cases, in the hands of a skilled acupuncturist, acupuncture does work well alone or when used in conjunction with physical therapy for the treatment of low back pain. The challenge with studies like these, is that in order to design a clean study, treatment approaches such as physical therapy are forced into cookie-cutter guidelines that do not accurately reflect what good physical therapy is. In my experience, the best results are achieved with a highly individualized approach, whether it’s acupuncture or physical therapy. Upon reading the full text of this article, it is apparent that the “conventional therapy” offered in this study in Germany is quite different than good physical therapy here in the United States. I would encourage readers to seek out practitioners who address their individual needs rather than rely on results from a study that examines very non-specific back pain.

I think all the people questioning the exact format for the “sham” acupuncture are onto something. Just because we call it a sham doesn’t mean it is. Look at the results.

Back pain can be tricky to treat. I’ve heard of a Swedish study where people with back pain were divided into three groups. One group was told to take it easy and resume their regular activities as soon as they could. They were on their own, no treatment. The next group was treated with massage. The third group was treated with massage and physical therapy exercises.

To my surprise, the first group (the “on their own” people) healed the best and quickest, experienced the least pain, and regained the highest percent of their previous function. They also had the lowest satisfaction with the program. The third group, the group with massage and exercise, had the highest level of satisfaction with the program, but experienced the most pain, took the longest to recover, and recovered the lowest percentage of their previous function.

For me, that study says that people are not served by being passive in their recovery. The modality of treatment succeeds most based on the involvement of the injured person. I hope this NY Times article provides information and incentive for people to act on their health and fitness. But, of course, fitness training is my business.

DOES THE OUT BRAKE OF SMALL RED DOTS ON THE SKIN AROUND THE NECK AND REAR OF HEAD AND FACE — ? HAVE ANY THING TO DO WITH EATING OYSTERS, RAW ? OR COULD THIS MEAN SOMETHING ELSE– AS THIS IS HAPPING TO ME. NOW… OR AM I EATING TO MUCH SWEETS. SHOULD I SEE SOMEONE ON THIS OR QUIT EATING TO MUCH JUNK FOOD— THANKS MARLEY
From TPP — You should also see a doctor if you have skin lesions of unknown origin.

“One must realize that [[[oriental]]] medicine is based upon a different philosophical model and paradigm than Western medicine. The principles of [[[oriental]]] medicine”

— Posted by Dr Richard Connell, DOM

“ORIENTAL”?

How do you editors allow racist ethnic slurs to be posted? Does the Times support racism?

From TPP — You are correct that the word “Oriental” is sometimes considered offensive when used as a noun. However the term “Oriental medicine” is commonly used to describe a branch of medicine, and in the context, the word “Oriental” is not considered pejorative. . In fact, one of the leading groups associated with this branch of medicine is called the American Association of Accupuncture and Oriental Medicine. Schools, such as the Pacific College of Oriental Medicine, also use the term. The reader who used this term used in a respectful manner to describe a specific branch of medicine, which is why I posted his comment.

The issue is not the result of standard vs less than standard accupuncture. The issue is that standard western medicine does no better than either. Real or sham, we must consider how these terms apply to any medical care received (MCR). We also have to ask even more important questions about the $2.2 trillion spent on MCR.

When this study’s findings are coupled with the the results described in another recent study on the cost and value of standard back pain treatment (recently reported in the NYT and other media outlets), it should be quite clear that a lot of MRC is costly and less effective than we have been lead to believe. This study of standard orthopeadic MCR showed that after inflation, all standard back pain therapies cost 67% more than just a few years ago and after six months of standard treatment modalities, these real orthopeadic interventions produced no lasting improvement for the patients.

I would suggest that the same is true for most diagnostic tests and treatment of cancer, diabetes, heart, Alzhemier’s, autism, auto-immune diseases, etc.

This suggestion has a simple proof: Look around! All of these diseases are still the leading killers or disruptors of normal living. Ask yourself how many people you know who have these conditions! How many Americans are overweight, obese, diabetic, have heart disease, high blood pressure, high (bad) cholesterol, are taking costly prescription drugs, receiving chemo, and radiation therapy?

Want more information that indicates some areas for improvement in MCR as presented at the National Congress on the Un and Underinsured (Washington, D.C., December 2007), e-mail healthinfo@delhitel.net. Please put Presentation Request in Subject line and your name, phone and affiliation in the text section.

The results reported here force us to revisit the use of “sham” and “real” as well as understanding and accepting what really works or doesn’t.

Here is what is reported:

“Nearly half the patients in the acupuncture group reported significant relief, compared to just 27 percent in the conventional therapy group. But nearly as many people in the fake acupuncture group — 44 percent — also reported significant relief.”

Add these findings to another study reported in the media about the cost and success of orthopeadic treatment for back pain and we see that conventionial care is costly and might not be as effective as we have been led to believe.

So what is a sham? What is effective? What do we do?

Solutions are not easy to find once sick or limited in movement. A better course is to seek health through life style and avoidance of injury by safe actions.

I believe I personally have seen demonstration that “real” accupuncture did block nerve impulse. The alternatives did not mention chiropractic or orthopedic manipulation. How much back pain is related to organs, digestive and processing obstruction?

Not very impressive study based on clinical data. Superficial medical report and not very valuable.

What researchers do not realize is that there are numerous Acupuncture points that will work for back pain. For Example in my clinic at Tree of Life Acupuncture in New York, we use Master Tung’s family Acupuncture style. I often use now points on the head face, feet and wrists to relief back pain.

P.S.
In most cases I see in my private practice, majority of my clients about %70 get pain relieve in about 1-3 minutes upon needle insertion. That’s a fact in most cases and there are some exceptions of course (after bad surgery, severe car accident or heavy drugs (pain medications). Acupuncture works !

It would have been interesting for the researchers to ask the participants if they believed the treaatment was going to help them. The placebo effect is very strong and if people believed they were getting the ‘effective’ treatment that could easily influence the outcome.

Te reason why “fake” acupuncture works just as well as the “real” thing, it is because traditional theories for selecting “real” points and means of stimulation are not based on an empirical rationale, but on ancient cosmology, astrology and mythology. These theories significantly resemble those that underlined European and Islamic medicine and bloodletting in the Middle-Ages. Their origin is discussed in the following article:

As a Licensed Acupuncturist in New York, I treat a lot of pain.
Back Pain and Sciatica is most common in our office.
Natural therapy like Acupuncture is much safer and works faster in many cases than toxic drugs.

I’m thrilled that more and more research continually is being done that proves the benefits of acupuncture and holistic medicine as compared to Western medicine, and that the New York Times is doing articles on the subject. But I have an issue with the fact that the first paragraph of this article is somewhat misleading as to the overall results shown by the study cited. It seems to be implying that fake acupuncture works just as well in the long-run, but later in the article it is shown that there is a drastic difference between the real and fake acupuncture results in that real acupuncture treatments provided lasting pain-relief without the use of drugs.

The spin of the article initially should be that sham acupuncture can create temporary relief, and when a patient has real acupuncture the patient not only gets that but also the increased health and curing of the issue as well. The real indication of a positive result, or a goal reached, is whether something gets cured. “Real”acupuncture has been shown to increase health to the area affected by pain such that the goal is long-term relief and a reduction or elimination of symptoms. An argument can be made the study shows that various treatments can provide temporary relief, but that over time, real acupuncture is of great benefit. Or, for example, you could put ice or a shot of novacaine at the area of pain, but that’s not solving the problem.

The concept of sham acupuncture is a big issue, and the article does not address this. Just because the sham study used “non-traditional” points doesn’t mean that the points used, especially in the area of the back, weren’t additionally effective. For example, Japanese-style acupuncture is the insertion of needles into just the surface of the skin and does not involve manipulation. As well, treating back pain or any pain in the body, from a traditional Chinese medicine perspective, often requires the use of traditional acupuncture points plus “ashi” points, which are “non-traditional” points. So the question of whether an actual “sham study” can be performed can be rightfully raised.